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Medicare and HIV med costs
Jan 30, 2012

I have health insurance that is self paid at work that covers my HIV meds now. I am 61 and plan on retiring at age 65, my current health care coverage ends and will then be based entirely on Medicare. Will Medicare cover the cost of my HIV meds which currently run about 20 thousand a year? What is the issue of a gap in coverage of medications when someone is first enrolled in Medicare. Thanks

Response from Mr. Chambers

If your only coverage is Medicare, then Part D will cover your medications, and virtually all HIV medications must be covered by all Part D plans.

By law, there is a deductible and 75% coverage, however most drug plans usually apply co-pays and some waive the deductible. The infamous "donut hole", that part of Part D where nothing is covered, is slowly shrinking and will be gone by 2020. Right now, brand name drugs are covered at 50% in the donut hole and that coverage will increase annually until all medications, brand and generic, are covered at 75%. Drawback there is that with many HIV drugs, 25% can still amount to a lot of money.

Anthem Blue Cross PPO $35 Copay GenRx Plan
New HIV diagnosis

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